<%@page import="sy.pageModel.Member"%>
<%@ page language="java" pageEncoding="UTF-8" contentType="text/html; charset=UTF-8"%>
<script type="text/javascript">
</script>
<div align="center">
	<form id="admin_order_drug_addForm" method="post">
		<table class="tableForm">
			<tr>
				<th>卡号</th>
				<td>
				    <input name="cardId" class="easyui-validatebox" data-options="required:true" />
				</td>
				<th></th>
				<td><input type="button" id="btnGetMemberInfo" value="获取会员信息" onclick="getMemberInfoByCardId('${pageContext.request.contextPath}', 'admin_order_drug_addForm');"/>
				</td>
			</tr>
			<tr>
				<th>姓名</th>
				<td><input name="name" readonly="readonly" class="easyui-validatebox" data-options="required:true"/>
				</td>
				<th>手机号</th>
				<td><input name="mobile" readonly="readonly" class="easyui-validatebox" data-options="required:true"/>
				</td>
			</tr>
			<tr>
				<th>身份证号</th>
				<td><input name="cid" readonly="readonly" class="easyui-validatebox" data-options="required:true"/>
				</td>
				<th>出生日期</th>
				<td><input name="bornDate" readonly="readonly" class="easyui-validatebox" data-options="required:true"/>
				</td>
			</tr>
			<tr>
				<th>性别</th>
				<td>
				    <select name="gender">
					<%for(String key : Member.MEMBER_GENDER_MAP.keySet()) {%>
						<option value="<%=key%>"><%=Member.MEMBER_GENDER_MAP.get(key)%></option>
				    <%}%>
					</select>
				</td>
				<th>申请服务时间</th>
				<td><input name="serviceTime" onFocus="WdatePicker({readOnly:true,dateFmt:'yyyy-MM-dd HH:mm:ss'})" /></td>
					
			</tr>
			<tr>
				<th>生产厂家</th>
				<td><input name="factory" class="easyui-validatebox"/>
				</td>
				<th>经销商</th>
				<td><input name="dealer" class="easyui-validatebox"/>
				</td>
			</tr>
			<tr>
				<th>是否需要发票</th>
				<td>
				    <input type="radio" name="isNeedInvoice" value="1" checked/>否
				    <input type="radio" name="isNeedInvoice" value="0"/>是
				</td>
				<th>是否需要配送</th>
				<td>
				    <input type="radio" name="isNeedDeliver" value="1" checked/>否
				    <input type="radio" name="isNeedDeliver" value="0"/>是
				    <input type="hidden" name="drugItems"/>
				</td>
			</tr>
			
		</table><br>
		<table style="width:98%">
		    <tr>
				<th colspan=5>需要购买的药品信息</th>
			</tr>
			<tr>
				<th colspan=5><hr></th>
			</tr>
			<tr>
				<th>名称</th>
				<th>规格</th>
				<th>剂型</th>
				<th>数量</th>
				<th>具体需求</th>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
			<tr valign="top">
				<td align="center"><input name="drugName" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugStandard" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugType" class="easyui-validatebox"/></td>
				<td align="center"><input name="drugCount" class="easyui-numberbox" min="0" precision="0" style="width:30px"/></td>
				<td align="center"><textarea name="drugRequirement" class="easyui-validatebox"></textarea></td>
			</tr>
		</table>
	</form>
</div>